慢性阻塞性肺疾病患者抑郁、焦虑情绪调查

目的：发现慢性阻塞性肺疾病（COPD）病人伴抑郁、焦虑情绪的患病率，并分析其相关的影响因素。方法：对62例COPD患者进行了一般情况及医院焦虑抑郁量表（Hospital Anxiety and Depression Scale，HAD）问卷调查。结果：有抑郁情绪的患者42人（67．7％）。有焦虑情绪的患者的43人（69．3％）。14例Ⅲ级COPD患者中达到抑郁、焦虑症状肯定存在标准的均有13人，高达92．8％。Logistic多因素回归分析，男性比女性病人更易出现抑郁和焦虑症状（OR值分别为1．05，95％CI1．01-2．11，1．12，95％CI1．03-2．23），肺功能差的患者更易出现抑郁和焦虑症状（OR值分别为2．34，95％CI1．98-3．21，2．53，95％CI2．11-4．01）；对病情越了解的病人更易出现抑郁和焦虑症状（OR值分别为1．22，95％CI0．98-1．54，1．25，95％CI1．01-2．31）。结论：COPD患者中存在较高的抑郁及焦虑情绪障碍，肺功能受损程度是其主要影响因素。     

不同分娩方式对产妇心理影响

本文采用抑郁自评量表（ＳＤＳ），焦虑自评量表（ＳＡＳ）对１５５例孕产妇作了产前、产后心理状况调查，结果显示：产前、产后ＳＡＳ总分值高于常模值；产后ＳＤＳ分值高于产前，剖腹产者ＳＡＳ，ＳＤＳ高于常模值，也高于自然分娩者（均为Ｐ＜０．０１）。ＳＤＳ抑郁严重度指数≥０．５者：剖腹产２５例（３６．７６％），自然分娩者５例（５．２５％）。提示产前产后孕产妇有明显焦虑情绪，剖腹产后有明显抑郁。     

学龄儿童的抑郁

３２２名１０～１２岁小学五、六年级学生填写了Ｂｕｌｅｖｕｅ抑郁量表（ＢＩＤ）。抑郁症状的出现率３．４％～１１．５％，有自杀观念者５．９％。自杀观念与总分、心境恶劣、自卑和自杀、攻击性行为和社会交往４个因子的相关程度最高。３２２人中１０人（３．１％）为抑郁症检出者，临床表现与成人抑郁症相似，其中８人有自杀观念。结果提示抑郁情绪、自杀观念、抑郁症在学龄儿童中的出现率较高，应加强预防和治疗。     

2型糖尿病患者焦虑抑郁情绪与社会心理因素的关系

目的：探讨2型糖尿病患者焦虑、抑郁情绪与心理压力、应对方式和社会支持的关系。方法：采用自填式问卷，对172名2型糖尿病患者进行调查，了解患者的一般情况、心理压力来源、病人应对措施、社会支持等社会心理因素，同时用医院焦虑抑郁量表（HAD）测量其焦虑与抑郁情况。结果：焦虑得分≥9分者35人，占20．3％；抑郁得分≥9分者33人，占19．2％。控制性别、年龄、婚姻状况、学历、经济收入等潜在的混杂因素后的多因素logistic回归分析表明，感受“担心疾病可能造成的伤害”（OR=1．76，95％CI=1．12-2．77）、“疾病造成的社会／家庭危机感”（OR=1．85，95％CI=1．18-2．92）、“担心身体／生理功能下降”（OR=2．16，95％CI=1．28～3．67）和“担心经济条件降低”（OR=2．03，95％CI=1．27～3．26）的压力越大，对疾病越多采取“消极应对”的措施（OR=1．94，95％CI=1．26-2．97），越容易出现焦虑情绪：感受“疾病造成的社会／家庭危机感”（OR=1．79，95％CI=1．09～2．96）、“担心身体／生理功能下降”（OR=2．89，95％CI=1．59-5．24）的压力越大，对疾病越多采取“消极应对”的措施（OR=1．95，95％CI=1．23～3．11），越容易出现抑郁情绪，较多采取“逃避”的应对措施者较少出现抑郁情绪（OR=0．52，95％CI=0．30-0．90）。结论：2型糖尿病人的焦虑、抑郁情绪与疾病引起的心理紧张和病人采取的应对方式有关。     

52例原发性高血压患者情绪状态调查

用ＳＡＳ和ＳＤＳ，对经过系统干预的原发性高血压患者进行情绪障碍调查，结果显示，ＳＡＳ、ＳＤＳ均分与常模比较，无显著性差异；焦虑和抑郁的发生率较低（分别为２１．１５％和２５％）。提示干预对改善患者情绪、提高疗效有积极作用。     

综合性医院冠心病病人抑郁/焦虑现况研究

目的：了解综合性医院冠心病患者抑郁和／或焦虑症状患病率及既往诊治情况。方法：采用现况研究方法，于2004年6月1日到12月1日在北京、上海、广州和成都的7家综合性医院的心内科连续收集确诊的冠心病患者359例。由经培训的调查员用统一的调查表进行面对面调查，同时使用综合医院焦虑抑郁量表（HAD）、Hamilton焦虑量表和Hamilton抑郁量表进行心理测评。结果：冠心病患者的抑郁症状、焦虑症状、抑郁合并焦虑症状以及合计的抑郁和／或焦虑症状患病率分别为19．8％，16．7％，13．6％和22．8％；在具有抑郁和／或焦虑症状的非首诊患者中，冠心病患者既往被诊断为抑郁和／或焦虑障碍和接受抗抑郁和／或焦虑治疗的比例均低于4％：住院患者在本次住院期间的抑郁焦虑诊治率低于1％。结论：综合医院冠心病病人具有较高的抑郁和／或焦虑症状和抑郁和／或焦虑障碍患病率．且既往诊治率较低。     

基层卫生保健中抑郁发作诊断治疗的初步调查

使用ＷＨＯ提供的基层卫生保健病人特征问卷（ＰＨＣＰＣＱ），调查了北京市某区级医院连续就诊的２００例病人，１２项精神症状调查结果显示，其中９人至少存在６项，使用ＩＣＤ－１０研究用抑郁发作诊断标准由专科医生重新诊断应为抑郁发作病例，占４．５％，而基层卫生保健医生病历记录中有诊断抑郁发作者仅１例，占０．５％，二者差异有显著性，表明一些抑郁症病人可能会被基层卫生保健医生漏诊；精神药物的使用调查结果显示，苯二氮类药物最多，共３２例（１６％），抗抑郁剂仅１例（０．５％）；结果提示，对基层卫生保健医生进行有关抑郁症诊断治疗方面的培训是十分必要的。     

新兵焦虑、抑郁情绪测查及影响因素分析

目的：探讨新兵焦虑、抑郁情绪的发生情况及其影响因素，为新兵训练过程中的心理学干预提供依据。方法：应用焦虑自评量表（SAS）、抑郁自评量表（SDS）及自编24项背景因素调查表，对1700名男性新兵进行心理测试。结果：①1642名新兵中轻度焦虑133人（8．1％），中重度焦虑30人（1．8％）；轻度抑郁233人（14.2％），中重度抑郁83人（5．2％）。②SAS，SDS评分显示：非独生子女焦虑和抑郁的阳性率和严重程度明显高于独生子女（P〈0．05）。③SAS，SDS评分还与人际关系适应程度、是否独生子女、休息情况、与家人通讯是否良好、是否单亲家庭及受表扬情况等6项因素显著相关。结论：新兵中存在焦虑和抑郁症状者约占9．9％及19．4％，非独生子女焦虑和抑郁的严重程度高于独生子女。     

帕金森病患者认知功能障碍与抑郁和脑白质疏松症的关系

目的：探讨帕金森病（PD）患者的认知功能障碍与抑郁和脑白质疏松症（LA）的关系。方法：采用简易精神状态量表（MMSE）和临床记忆量表（CMS）、汉密尔顿抑郁量表（HAMD）检查70例PD患者及40例健康对照者的认知功能及情感状态，并比较其认知障碍的程度。结果：①PD组、PD合并LA组、抑郁组MMSE及CMS评分除无意义图形再认外均显著低于对照组（P〈0、05～0、01）；②PD合并LA组MMSE及CMS评分均娃著低于无LA组fP〈0．01）；③抑郁组MMSE及CMS评分除无意义图形再认外均显著低于非抑郁组（P〈0．01）；（4）PD合并LA组中度认知功能障碍5例（27．8％），痴呆11例（61.1％）；PD抑郁组中度认知功能障碍6例（17.6％），痴呆13例38．2％）。结论：PD合并LA及伴发抑郁状态者更易产牛认知功能障碍，合并LA组存在较全面而严蘑的认知功能障碍，抑郁组认知功能的损害主要表现为词语记忆的损害。     

帕罗西汀并心理干预治疗卒中后抑郁和焦虑共病者81例临床观察

目的：探讨脑卒中后抑郁和焦虑共病对患者生活能力和神经功能康复的影响，及帕罗西汀合并心理干预临床疗效。方法：将脑卒中伴抑郁和焦虑障碍共病者81名随机分成3组，分别接受单用帕罗西汀治疗（A组）、帕岁西汀并心理治疗（B组）以及单用脑血管药物治疗（C组）。采用斯堪的那维亚脑卒中量表、Barthel指数、汉密尔顿抑郁量表、汉密尔顿焦虑量表评估疗效。结果：脑卒中患者中，抑郁和焦虑的共病率为65．9％，A组、B组各项评分与C组比较，差异均有统计学意义。结论：卒中后抑郁和焦虑病人单用帕罗西汀或合并心理治疗均能促进患者神经功能康复和提高生活质量，且帕罗西汀并心理干预的疗效更好。     

Peripartum changes in social support among women with and without anxiety and depressive disorders prior to pregnancy: a prospective-longitudinal study

This study aims to prospectively examine peripartum changes in social support in women with and without anxiety and depressive disorders prior to pregnancy. Data come from the Maternal Anxiety in Relation to Infant Development (MARI) Study, a prospective-longitudinal investigation among n?=?306 expectant mothers. DSM-IV anxiety and depressive disorders were assessed in early pregnancy using the Composite International Diagnostic Interview for Women (CIDI-V). Social support was assessed with the Social Support Questionnaire during pregnancy as well as 4 and 16 months postpartum. Perceived social support in the total sample declined from prepartum to postpartum. Levels of prepartum and postpartum social support were lower in women with comorbid anxiety and depressive disorders compared to those with pure depressive disorder(s), pure anxiety disorder(s), or comorbid anxiety and depressive disorders prior to pregnancy. Moreover, social support more strongly declined from prepartum to postpartum in women with comorbid anxiety and depressive disorders compared to those without anxiety and depressive disorder prior to pregnancy. Findings suggest that women with a previous history of comorbid anxiety and depressive disorders are at particular risk for deficient social support during pregnancy and after delivery and might thus profit from targeted early interventions.     

Cognitive therapy for depressed adults with comorbid social phobia

BACKGROUND: Evidence suggests that comorbid depression influences the outcome of cognitive-behavioral treatment for patients presenting with social phobia. Little is known, however, about the influence of comorbid social phobia on the response to cognitive therapy (CT) for depression among adults presenting with recurrent major depressive disorder (MDD). These analyses seek to clarify this relationship. METHODS: Patients (N=156) with recurrent DSM-IV MDD entered CT (20% also met DSM-IV criteria for social phobia). Every week during the course of CT, clinicians assessed depressive symptoms and patients completed self-report instruments measuring severity of depression and anxiety. RESULTS: At presentation, outpatients with comorbid social phobia reported greater levels of depressive symptoms and clinicians rated their impairment as more severe, compared to their counterparts without social phobia. Patients with or without comorbid social phobia did not differ significantly in (1) attrition rates; (2) response or sustained remission rates; (3) time to response or sustained remission; or (4) rate of improvement in symptoms of depression or anxiety. LIMITATIONS: The lack of domain-specific measures limits inference with respect to the improvements in social anxiety that occur with CT of depression. CONCLUSIONS: These findings introduce the hypothesis that CT for depression may be flexible enough to treat the depressive symptoms of patients presenting with MDD who also suffer from social phobia.     

Psychosocial work characteristics,sleep disturbances and risk of subsequent depressive symptoms: a study of time‐varying effect modification

Job strain and low social support at work are recognized risk factors for depression. However, people with poor sleep may represent a high‐risk group more likely to benefit from interventions against work stress. The present study examined whether the associations between these work stressors and depressive symptoms differed by strata of sleep disturbances (effect modification/effect moderation) considering repeat measures of work characteristics and sleep. The study was based on five biennial measurements of the Swedish Longitudinal Occupational Survey of Health, including 1537 respondents recurrently in paid work, from an originally representative sample of the Swedish working population. High work demands, low decision authority and low social support were measured waves 2 and 4, sleep disturbances (putative moderator/modifier) waves 1 and 3, and depressive symptoms (outcome) wave 5. Causal effect modification, whether the effect of working conditions differed by strata of sleep disturbances, was analysed by structural nested mean modelling estimated using a regression‐with‐residuals with inverse‐probability‐of‐treatment weighting approach. High demands and low social support, but not low decision authority, influenced subsequent depressive symptoms. The relationship between social support and depressive symptoms was not apparently modified by sleep disturbances. However, disturbed sleep wave 3 modified the effect of high demands wave 4 (coefficient 1.77, P < 0.05) on depressive symptoms wave 5. The results indicate that high job demands is a stronger risk factor for depressive symptoms in people with pre‐existing sleep disturbances, suggesting that targeted workplace interventions may be more effective when it comes to preventing negative effects of job demands.     

The relationship of hope and illness-related uncertainty to emotional adjustment and adherence among pediatric renal and liver transplant recipients

OBJECTIVE: To examine, using partial least squares (PLS) modeling, the associations among hope, illness-related uncertainty, anxiety, depression, and adherence in a sample of children with renal and liver transplantations. METHODS: Seventy pediatric renal and liver transplant recipients and their caregivers participated in a 3-month study which involved completing questionnaires and monitoring adherence via self-report and electronic monitoring (MEMS caps). A PLS estimation procedure was used to examine the associations among constructs in the theoretical model. RESULTS: Hope and uncertainty were associated with both depressive symptoms and anxiety, and depressive symptoms were associated with treatment adherence. The association of hope and adherence to treatment was fully mediated by depressive symptoms. CONCLUSIONS: Findings suggest mechanisms for identifying patients that may be at risk for nonadherence and components for intervention programs to improve adherence rates among pediatric transplant recipients.     

Anxiety and depression in a community sample: the influence of comorbidity on social functioning

The main aim of the present study was to examine whether the well-established association between depression and social dysfunction still remains when effects of a coexistent anxiety disorder are eliminated from the data. As these effects strongly depend on the proportion of depressed subjects suffering simultaneously from an anxiety disorder, we first examined the frequency of mixed and pure depressive disorders and that of pure anxiety disorders (control subjects) in a community sample (n = 483). Using DIS/DSM-III criteria (reference period 6 months), pure anxiety disorders were most frequent (6%), followed by pure depressive disorders (3%) and the coexistence of anxiety and depression (2%). Cases suffering from both disorders were most severely afflicted in terms of psychopathology (persistence of symptoms, comorbidity regarding other mental disorders). At the diagnostic level, the association between depression and social dysfunction was only slightly influenced by effects resulting from comorbidity; at the level of actual symptoms, however, we found that cases suffering simultaneously from severe depression and severe anxiety were significantly more handicapped in their social lives than depressive subjects with only mild anxiety symptoms.     

Major depression in patients with panic disorder: factors associated with course and recurrence

The relationship between anxiety and depressive disorders has been the subject of considerable interest and controversy. In this study, the occurrence and course of affective illness was systematically examined in 63 patients meeting DSM-III-R criteria for panic disorder. Forty (63%) of the patients had experienced at least one major depressive episode. Of these, 13 (32.5%) experienced their first depressive episode prior to the onset of panic disorder, 15 (37.5%) experienced their first depressive episode after the onset of panic disorder, and in 12 (30.0%) the onset of the disorders was concurrent. Patients with agoraphobia had comparable rates of depression (68%) to patients without agoraphobia (53%, P = NS), and they had similar temporal patterns of depressive illness. Comorbidity with social phobia was associated with an increased longitudinal likelihood of major depression compared to patients without this comorbid diagnosis (P less than 0.05). Patients with longer duration of illness, early onset depression, melancholic depression, or family histories of anxiety or depression had an increased likelihood of having experienced recurrent depression. These findings are discussed in the context of current theories regarding the development of affective illness in patients with anxiety disorders.     

Social adjustment in in-patients with affective disorders: predictive factors

We assessed social adjustment in 145 depressed in-patients using the self-reporting Social Adjustment Scale (42-item version) to evaluate the contribution of demographic and clinical variables and examine social functioning at different levels of depression. Our results indicate that the presence of a psychopathology in association with interpersonal sensitivity, hostility and perceived social support aspects -- and not the severity of current depressive symptoms -- were the most important factors affecting social adjustment. As expected, social disturbances are more pronounced in severe depressives who experience difficulties in all areas: by contrast, patients with low depressive symptom levels do not appear to be maladjusted, by comparison with a community sample.     

Clinical correlates of anxious depression among elderly patients with depression

OBJECTIVE: The purpose of this study was to determine the clinical correlates of comorbid anxiety and depression in a sample of older patients with major depression. METHODS: 352 patients aged 59 and older with major depression were enrolled in the Study of Depression in Later Life at Duke University, of whom 148 met criteria for lifetime generalized anxiety disorder. Participants completed self-report assessments of performance in basic and instrumental activities of daily living, social support, suicidal ideation, life satisfaction, and stressful life events. Cognitive assessment was done with the Mini-Mental State Examination. RESULTS: The prevalence of lifetime anxiety in our depressed sample was 42%. Patients with anxious depression were significantly younger, and had greater suicidal ideation, more impairment of subjective social support, and more severe depressive symptoms. CONCLUSION: In elderly patients with anxious depression, psychosocial support and suicidal ideation should be assessed. Whether improvement of subjective social support leads to reduction in anxious depression should be investigated.     

Comorbidity of asthma and anxiety and depression in Puerto Rican children

Studies have reported that childhood asthma is associated with internalizing disorders, but most of these studies have used global measures of depressive and anxiety symptoms. The Diagnostic Interview Schedule for Children was administered to a group of 1891 youth ages 4 to 17 and their caregivers in Puerto Rico to determine DSM-IV symptoms and diagnoses. Asthma diagnosis and having had an asthma attack were assessed by parental report. A diagnosis of asthma was associated with having any depressive disorder and one symptom of separation anxiety. An asthma attack was associated with any depressive disorder and any anxiety disorder and, more specifically, with separation anxiety disorder, major depressive disorder, and symptoms of depression, separation anxiety, and generalized anxiety. Possible explanations for the findings are discussed.